Department of Neurosurgery, Korea University College of Medicine, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Neurosurgery. 2023 May 1;92(5):986-997. doi: 10.1227/neu.0000000000002308. Epub 2022 Dec 29.
The purpose of intracranial arteriovenous malformations (AVMs) treatment is to prevent bleeding or subsequent hemorrhage with complete obliteration. For large, difficult-to-treat AVMs, multimodal approaches including surgery, endovascular embolization, and gamma knife radiosurgery (GKRS) are frequently used.
To analyze the outcomes of AVMs treated with single-session, neoadjuvant, and adjuvant embolization GKRS.
We retrospectively reviewed a database of 453 patients with AVMs who underwent GKRS between January 2007 and December 2017 at our facility. The obliteration rate, incidence of latent period bleeding, cyst formation, and radiation-induced changes were compared among the 3 groups, neoadjuvant-embolized, adjuvant-embolized, nonembolized group. In addition, the variables predicting AVM obliteration and complications were investigated.
A total of 228 patients were enrolled in this study. The neoadjuvant-embolized, adjuvant-embolized, and nonembolized groups comprised 29 (12.7%), 19 (8.3%), and 180 (78.9%) patients, respectively. Significant differences were detected among the 3 groups in the history of previous hemorrhage and the presence of aneurysms ( P < .0001). Multivariate Cox regression analyses revealed a significant inverse correlation between neoadjuvant embolization and obliteration occurring 36 months after GKRS (hazard ratio, 0.326; P = .006).
GKRS with either neoadjuvant or adjuvant embolization is a beneficial approach for the treatment of AVMs with highly complex angioarchitectures that are at risk for hemorrhage during the latency period. Embolization before GKRS may be a negative predictive factor for late-stage obliteration (>36 months). To confirm our conclusions, further studies involving a larger number of patients and continuous follow-up are necessary.
颅内动静脉畸形（AVM）的治疗目的是预防出血或随后的出血，并实现完全闭塞。对于大型、难以治疗的 AVM，通常采用包括手术、血管内栓塞和伽玛刀放射外科（GKRS）在内的多模态方法。
分析单次、新辅助和辅助栓塞 GKRS 治疗 AVM 的结果。
我们回顾性分析了 2007 年 1 月至 2017 年 12 月在我们机构接受 GKRS 治疗的 453 例 AVM 患者的数据库。比较新辅助栓塞组、辅助栓塞组和非栓塞组的闭塞率、潜伏期出血、囊肿形成和放射性改变。此外，还研究了预测 AVM 闭塞和并发症的变量。
共纳入 228 例患者。新辅助栓塞组、辅助栓塞组和非栓塞组分别包括 29 例（12.7%）、19 例（8.3%）和 180 例（78.9%）患者。3 组间既往出血史和动脉瘤存在情况存在显著差异（P<0.0001）。多变量 Cox 回归分析显示，新辅助栓塞与 GKRS 后 36 个月闭塞之间存在显著负相关（风险比，0.326；P=0.006）。
GKRS 联合新辅助或辅助栓塞治疗具有高度复杂血管构筑的 AVM 是一种有益的方法，这些 AVM 在潜伏期内有出血风险。GKRS 前栓塞可能是晚期闭塞（>36 个月）的负预测因素。为了证实我们的结论，需要进一步进行涉及更多患者和持续随访的研究。
